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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 58. Go back in thread:
Posted by SLS on July 9, 2005, at 21:31:09
In reply to Maybe I shouldn't have posted... » linkadge, posted by Racer on July 9, 2005, at 13:20:53
> Maybe I shouldn't have posted this.
Why not?
Unfortunately, what you have drawn attention to is a ubiquitous topic of debate and contention. There should be none at this point in human history, but there is. To some, the world is still flat. For them, anything that upsets this notion often brings about defensiveness and a panicked attempt at expousing a liturgy without the enlightenment that humanity's objecive investigation into mental illness has demonstrated.
I think you are in agreement with most others along this thread that abnormal biological function contributes to most cases of Major Depressive Disorder (MDD) and Bipolar Disorder (BD). I see that there is some confusion here as to semantics and the descriptions of the details of the varying models of the etiologies of these disorders.
I think there is some confusion as to what a theory is.
Evolution is still a theory. We here this expression used all the time by those who would have us believe that evolution has not been proven. It has. It is a fact that it occurs. However, there are varying theories as to how it occurs. Likewise, it is now a fact that MDD and BD are illnesses involving brain function. However, there are varying theories as to how this occurs. One theory is that there is a chemical imbalance within the synapse between neurons. Other theories try to incorporate recent observations involving the abnormal structure and function of the brain.
Is depression the result of a chemical imbalance?
I don't know. However, I am sure that depression can be a disorder of the brain.
From the NIMH, NIH:
http://www.nimh.nih.gov/publicat/depresfact.cfm
"Evidence from neuroscience, genetics, and clinical investigation demonstrate that depression is a disorder of the brain. Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters—chemicals used by nerve cells to communicate—are out of balance. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better treatments."
- Scott
Posted by Phillipa on July 9, 2005, at 22:33:11
In reply to Re: The world is still flat., posted by linkadge on July 9, 2005, at 20:47:46
Again I'm simplistic. Just go to a psych hospital and watch what happens to a schizophrenic or Bipolar once their meds are adjusted. But there is abuse of the system too. Fondly, Phillipa
Posted by Sarah T. on July 9, 2005, at 22:37:13
In reply to Lou's response to aspect of this thread-hrmtolif?, posted by Lou Pilder on July 9, 2005, at 15:03:45
Psychotic people should be on medication. They should also be in therapy. Psychotic people with OCD should be on medication. They should also be in therapy. Psychiatry and psychotropic drugs are still deeply flawed, but it is painfully clear that, for some people, the alternative is far worse.
Posted by Racer on July 9, 2005, at 23:30:55
In reply to Racer, I understand what you're trying to say, posted by linkadge on July 9, 2005, at 15:54:50
I was certainly *not* suggesting that people avoid psychotropic drugs, Link. I was writing about this because I think there are a lot of people -- especially in the depths of depression -- who might read those pages and get freaked out. You said that you had gotten a bit freaked out once or twice yourself, right? Imagine being a newbie to depression, etc, and coming across those pages that say ADs are terrible and dangerous?
I doubt anyone still remembers when I first posted here -- maybe SLS? -- but I had just been prescribed Serzone, and was too worried to take it. (As it turned out, I was right to be concerned, but that's another topic...) I wanted more information about whether or not it would be safe for me before I took it. If I had been greeted by something that told me that psychiatric medications were dangerous, would shorten my life, were the wrong way to go, etc, well, I would have taken the acepromazine cocktail that I was already considering.
And you're right: too many people assume that those of us who choose to take psychiatric medications are doing it as a shortcut. They don't realize how many of us either are in therapy, or would like to be in therapy as well.
We're on the same team, Link. And I owe you a long email, but have gotten smashed lately with a couple of things...
Posted by linkadge on July 9, 2005, at 23:57:10
In reply to Not sure... » linkadge, posted by Racer on July 9, 2005, at 23:30:55
I definately agree with you and see where you're coming from.
I throw out a lot of ideas, essentially to learn more. But by no means am I condeming psychiatric meds as a whole.
Linkadge
Posted by gardenergirl on July 9, 2005, at 23:57:29
In reply to Regarding the whole Chemical Imbalance thing, posted by Racer on July 8, 2005, at 19:26:04
Posted by gardenergirl on July 10, 2005, at 0:05:33
In reply to Good rant (nm) » Racer, posted by gardenergirl on July 9, 2005, at 23:57:29
Critical thinking is a valuable skill to have, especially when evaluating treatment choices for your health.
I think one would do well to develop a good understanding of what the problem is, perhaps in collaboration with a consultant/professional; carefully and critically evaluate all treatment options, again perhaps along with a professional; make and implement a treatment decision; and then evaluate your decision, adjusting if necessary.
I think if I only read one side of an issue, I am cheating myself of data that likley would be useful in making my decision.
gg
Posted by Dr. Bob on July 10, 2005, at 8:43:44
In reply to Lou's response to aspect of this thread-nohop, posted by Lou Pilder on July 9, 2005, at 17:22:11
> A. The poster does not give examples of such
> B. The poster does not write an explanation of what that could mean.Please don't post anything that could lead others to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by Sarah T. on July 10, 2005, at 13:03:18
In reply to Racer, I understand what you're trying to say, posted by linkadge on July 9, 2005, at 15:54:50
>> If you want to post some new information go right ahead. But, will tell you this. The information had better be scientifically based, or I will brush it off.>>>> Linkadge>>>>>>
Hi, Linkadge,
I agree with you. When I was a teenager, someone gave me some excellent advice that I have repeated to myself many times over the years. I was very upset about something that someone else had said to me, so I discussed the problem with an older friend. He said, "Whenever something like this happens, look where it's coming from. Look at the source." This is so important in many areas of life, particularly when it comes to medical and scientific issues; however, even medical and scientific information should be examined carefully. For example, whenever I read a drug study, I always look to see who funded the research. If the company that is manufacturing the drug funded the study and stands to profit from the marketing of the drug, I know that I should approach the article with even greater scrutiny."Look where it's coming from," should also be applied to any advice dispensed by movie stars and other celebrities. There has been a lot in the press lately about Tom Cruise, $cientology, and Cruise's advice to Brooke Shields and others to avoid antidepressants, which ignorant Mr. Cruise referred to as "antipsychotics." It's disturbing that so many people value what movie stars have to say about everything from health care to politics. Tom Cruise has absolutely no medical or science background, and his behavior reveals that he desperately needs medication.
It's sad that, often, those with the severest forms of mental illness, those most in need of medication, are the ones who are most opposed to treatments that could help them lead fairly normal, productive lives.
Posted by linkadge on July 10, 2005, at 15:38:49
In reply to Re: Racer, I understand what you're trying to say » linkadge, posted by Sarah T. on July 10, 2005, at 13:03:18
I agree with you fullt. The people who are the most "well" are the ones who are the most accepting, and openminded.
When somebody comes to me and makes some careless remark such as this, I simply say to myself that "this says more about them, than it does about me"
Linkadge
Posted by FredPotter on July 10, 2005, at 23:59:06
In reply to Regarding the whole Chemical Imbalance thing, posted by Racer on July 8, 2005, at 19:26:04
Kidneys go physically wrong. So do livers. Chemically too. Why should the most complex organ in the body not go wrong too? Of course the mind/brain is in a complex functional relationship with behaviour and the world. Everything cuts 2 ways each set 180 deg to each other. To me the world is a sense experience. To the world I am a complex bunch of chemicals
Fred
Posted by paulbwell on July 11, 2005, at 0:51:09
In reply to Regarding the whole Chemical Imbalance thing, posted by Racer on July 8, 2005, at 19:26:04
> This is prompted by a thread above, which really bothered me. In that thread, several links were posted to a series of websites that are biased against the theory of chemical imbalances as the cause of mental illness, and are oriented away from medications as treatments for mental illness, including depression. I really want to say a few things about web sites like those, and to offer a few pieces of advice about reading such sights.
>
> First of all, because the web sites in question have a very strong anti-medication/anti-"chemical imbalance" theory viewpoint, whatever they write on those sites will support that stance. They are only choosing to write what supports their stance -- or seems to support it. Here's a little secret: much of the information such sites publish is offering half-truths, rather than giving you the full story. Read this sort of thing critically, and you can see that they leave out hard facts and figures, and they also leave out anything that might possibly support other views.
>
> For example, the first site posted above spent several paragraphs expressing the idea that no one can offer up the idea chemical levels of the MAOs in the brain. OK. That's true, the only way to check the levels directly is to slice up the brain in question, which will only show the levels at the time of death.
>
> That site did not mention that you can get a pretty good estimate of those levels by metabolites in the blood stream, or from a spinal tap, etc. And it also neglected another little bit of information: the drugs that are known to raise the levels of the monoaminic neurotransmitters in the brain ACTUALLY WORK! They relieve depression. They don't do much of anything for normal people, but for people with depression, they make a difference!
>
> I didn't look at the date of that site, but I'll be generous and assume that when it says that there is absolutely no evidence for a genetic or inheritible cause of any mental illness, it's because they did not see the article from New Zealand that showed exactly that: an allele directly passed on in a Mendelian pattern that causes vulnerability to depression.
>
> I'm also betting, though, that they're unwilling to recognize family studies that show relationships between family members with related disorders. After all, that's only anecdotal, when you come right down to it, right? There's no hard science there, right?
>
> Weeeellll....
>
> Actually, that is still science, and the studies taht have been done really do show that there's a genetic trait involved in most of these disorders. They just haven't got a specific gene -- or even a specific chromosome -- to point to for it. What's more, it's likely that many of these disorders are multi-genetic, or are caused by a number of related genetic patterns. And most everyone says that having the genes will make you vulnerable to an affective disorder -- NOT that the genes will cause it directly. Environment plays a key role, as does support structures in that environment. If a child suffers a major stressor, but has adequate social and familial support, that child may develop resistance to depression -- no matter what his or her genetic heritage.
>
> So, please, when you read what's written on the web, or in magazines or newspapers, or anyplace -- please question what is written. Many times there is a bias, and many times that bias will affect what information is offered. Don't just read and believe. Use your mind. As well as reading what is said, try to read what isn't said: are they offering hard facts? Numbers are great, although often the percentages that are offered only tell part of the story. Is there a clear bias? That needs to tell you something.
>
> In the case of the web site offered above, the sneering tone in which several paragraphs were written would have tipped me off to a problem -- why sneer, unless you're sure you're making your point? And in science, you're just not supposed to start out with a point in mind.
>
> Besides, this is the medication related board, so I'm guessing most of us here haven't given up on finding a medication that helps us, right? That doesn't mean that we won't also be giving therapy a go, which has been shown to be optimal in most studies -- combination of medications and psychotherapy -- it just means that we're taking a medication. I guess I think it's a bit thoughtless -- at best -- to post links to the scare-mongering anti-medication sites on this board.
>
> OK. I'm done ranting now. Please forgive me for muddying up the board.The Ozz man has no brain chemical imballance, only a family inhereted tremble-YER RIGHT
You don't do over 1000 LSD trips, snort Cocaine daily, and remain almost constantly drunk (4 bottles of Congac daily at worst) for 25 years and expect the brains chemistry to return to normal when you quit the drugs n Booze?
Cheers
Posted by so on July 11, 2005, at 12:00:04
In reply to Re: Regarding the whole Chemical Imbalance thing, posted by FredPotter on July 10, 2005, at 23:59:06
I won't weigh in here regarding the propriety of various psych drugs, though basic research will show that historically drugs once touted as the best of the best have later fallen in esteem. Drugs once presumed to be the best available have later been recognized as not the best approach, and such evolving understanding is likely to continue, even regarding some drugs in wide use these days.
It's just that I've never felt too persuaded by this chemical imbalance assertion. Which chemical is imbalanced? Is it a deficiency or an excess of that chemical? What is it imbalanced against? If there is too little serontonin to satisfy an increased number of receptor sites, are the chemicals imbalanced or has the architecture of neurons become "imbalanced"? Is diabetes a "Chemical imbalance"? Is liver disease a "chemical imbalance"? What about Alzheimers, with its atropy of neural networks? We can accurately describe the atropied networks as assemblages of imbalanced chemicals.
If most diseases result from some sort of deficiency or excess of various chemicals, how is "chemical imbalance" any more descriptive of diseases related to a particular organ such as the brain? As one writer points out, the term "Chemical imbalance" seldom if ever appears in scientific literature. It more often appears in contexts intended to encourage clients to comply with medical advice, or to encourage associates of a client to support medical advice. For the majority of clients and families it might be useful rhetoric, but for me, it hints that someone is offering a remedy they cannont fully explain, and it tends to alert me that there is more to the explanation than I am being offered in a cursory reference to a "Chemical imbalance". Without a more detailed explanation of how a drug is expected to cause an intended effect, I am unlikely to swallow any drug intended to alter my mental outlook.
Posted by Racer on July 11, 2005, at 12:35:39
In reply to Life is a chemical imbalance, posted by so on July 11, 2005, at 12:00:04
OK, since Scott pointed out that you won't find the phrase "Chemical Imbalance" in the scientific literature, I figured it was worth offering another two cents worth on the phrase itself...
I believe that it's used because of the stigma surrounding mental illness. Rather than a doctor trying to convince a patient that a mental illness like depression or bipolar is *not* just a character flaw, which might involve hours of discussions that lead nowhere, I think a lot of energy has been focussed on reinforcing the belief that these disorders are "real" in the sense that something like diabetes is real. Saying that there's an imbalance in the brain's chemical messengers can make it easier to convince someone to take a medication, even if that person wouldn't ever agree to take a "happy pill" or an antidepressant, simply because he or she won't cop to a mental illness.
Now, those of us on this board are not the average psychotropic drug takers, and certainly not the average SSRI takers. We are a sub-group who have chosen to educate ourselves about our medications, for whatever individual reasons we have for that choice, and we are generally not people who respond adequately to the first anti-depressant tried. (Or, in some cases, to the eighth anti-depressant tried, but that's another story...) I don't think we can use our own experiences as the norm.
Years back, I told a doctor that I needed to understand what was being prescribed to me, because depression was complex, and just being given a pill didn't work. She told me that, for most of her patients taking anti-depressants, they didn't *want* to know anything more than "take this pill daily" -- they didn't want to be involved in their care beyond taking their pills. That was a real shock to me, as you can imagine. It's worth keeping in mind, though, that a lot of people don't want to be involved in decision making about their care, and don't want to know anything beyond how many pills to take and when.
So, "chemical imbalance" is a handy phrase to be trotted out for many patients who can benefit from anti-depressants, and even handier for those people who know they need the meds, but can't bring themselves to try to explain it to others, because of the stigma attached.
Posted by so on July 11, 2005, at 13:08:11
In reply to Life is a chemical imbalance, posted by so on July 11, 2005, at 12:00:04
Another aspect of the matter is that, even is some mental irregularities are traced to genetic causes, obviously not all mental difficulty is genetic.
In some contexts, it is important for a person to understand they suffer from lingering stresses. Especially among inmate populations and among some recovering substance abusers, genetic factors might be present, but many of these people started life in traumatic environments that most likely effected the way they see the world now. Understanding that anger control problems today are related to childhood circumstances can help explain to a person why they might not be as well prepared for some environments as are others. Childhood trauma might very well effect chemical balances later in life, but reference to the chemical aspects might not best describe relevant social, cultural and contextual factors that a person must now learn to navigate, whether they use meds or not.
Posted by so on July 11, 2005, at 13:15:40
In reply to Regarding the whole Chemical Imbalance thing, posted by Racer on July 8, 2005, at 19:26:04
Posted by linkadge on July 11, 2005, at 16:20:00
In reply to Chemical Imbalance - generalizaton or specific? (nm), posted by so on July 11, 2005, at 13:15:40
We all try to seek ballance in our lives. Life can be difficult if thats what you are implying, that does not mean that the brain (when working properly) does not have the capability to deal with an extrordinary amount of insult.
I agree with much of what you say. But remember that these drugs showed their benefit first, and then the theory was implemented to try and explain the workings.Weather or not a sick patient is willing to accept improvement in the absence of a perfect and complete understanding is their choice alone.
So is the theory air-tight ? Of course not. It really comes down to a personal choice. If a particulat drug helps me, then I have to carefully weight the known with the unknown.
Linkadge
Posted by Phillipa on July 11, 2005, at 18:32:12
In reply to Life is a search for ballance. so, posted by linkadge on July 11, 2005, at 16:20:00
Posted by SLS on July 11, 2005, at 20:49:10
In reply to Life is a chemical imbalance, posted by so on July 11, 2005, at 12:00:04
CHEMICAL IMBALANCE?
Major Depressive Disorder = MDD
Bipolar Disorder = BD> It's just that I've never felt too persuaded by this chemical imbalance assertion. Which chemical is imbalanced?
Scientists don't yet know the exact series of brain abnormalities that exist in people with MDD or BD that lead to the expression of these disorders, but empirical observation yields evidence from several diverse disciplines that something just ain't right. Something remains in an anomolous state of dysregulation during not only the state of depression, but also in the biologically vulnerable individual who is not in a state of depression (trait).
In actuality, neuroscientists have identified MANY chemical abnormalities in the brains and bodies of MDD and BD patients. They just haven't reached the point of putting all of the pieces of the puzzle together yet.
All of life is a chemical process. The brain is perhaps the most complex assemblage of chemicals in the universe. Anything abnormal it its function is thus the result of a CHEMICAL IMBALANCE. The term is accurate.
- Scott
Posted by FredPotter on July 12, 2005, at 0:33:24
In reply to Re: Life is a chemical imbalance, posted by SLS on July 11, 2005, at 20:49:10
Hi Scott So depression is a particular modality of imbalance. For a severe kind of imbalance that is brief and temporary we need only listen to music, say something heavy on emotion such as a great aria from Tosca
Posted by SLS on July 12, 2005, at 9:42:08
In reply to Re: Life is a chemical imbalance » SLS, posted by FredPotter on July 12, 2005, at 0:33:24
> Hi Scott So depression is a particular modality of imbalance.
I was talking specifically about MDD and BD.
> For a severe kind of imbalance that is brief and temporary
What kind, specifically? What triggered or is producing this depression?
> we need only listen to music, say something heavy on emotion such as a great aria from Tosca
For some people who describe themselves as being depressed, this is true, I'm sure.
For people who experience ultradian rapid cycling BD, their mood states change over the course of hours and not days or weeks. Nothing exogenous seems to interrupt this cycle. Their biology is autonomous and self-perpetuating.
One of the reasons it is so difficult to discuss the topic of "depression" is that this one word is used to describe many things. It means different things to different people, and people often generalize their own experience with it to those of others. What's more, the interaction between the brain and the mind is complex; the two being virtually inextricable. This is why psychotherapy or other exogenous influences can produce biological changes in the brain. These changes often help change the course of MDD. It can help bring about a remission, and is especially helpful to prevent relapse once remission is achieved.
- Scott
Posted by Jakeman on July 12, 2005, at 20:52:07
In reply to Life is a chemical imbalance, posted by so on July 11, 2005, at 12:00:04
They featured a guy on the 60 minutes program the other night who developed Parkinson's at the same time he gained the ability to compose great works of classical music.
There are yogis who roam the streets of India getting their substanance from handouts. In this country those people would be labeled homeless and possibly insane.
In many tribal societies some of those who the west we would call schizophrenic are considered shamen.
My point I guess is that we in the industrialized west are overconcerned with the ideal of normalcy. No doubt that mental illness DOES CAUSE extreme pain, suicide. It has happened in my family. I just wish we could all could relax our views about what is correct. Perhaps being wrong in the head is very valuable. Perhaps if my uncle who killed himself in the 60's had todays medications he would still be alive. At the same time, if he did not feel condemned and ostracized maybe he could have lived with his depressions and delusions and flourished in his own way, hopefully with the the love and support of his family and community. But we are where we are.
Our psychiatrists and therapists are substitutes for something that's been lost. I don't blame them, they do they best they can.
Thanks for your all's posts. Great discussion.
warm regards ~Jake
Posted by Declan on July 13, 2005, at 1:05:07
In reply to Re: Life is a chemical imbalance, what is normal, posted by Jakeman on July 12, 2005, at 20:52:07
"Our psychiatrists and therapists are substitutes for something that's been lost".............Thanks for that Jake.
Declan
Posted by linkadge on July 13, 2005, at 6:59:33
In reply to Re: Life is a chemical imbalance, what is normal, posted by Declan on July 13, 2005, at 1:05:07
I agree that our society is incomplete. It is the sensitive people who are bothered enough by it to become depressed. The "well" don't give a rats behind about whats really missing and go on in their lives in presuit of pleasure.
For instance, cutting in children is on the rise. That scares the hell out of me. That scares the absolute hell out of me. They're not imballanced, but we are trying to shove our rat race lifestyle in their face but they can't handle it. So when adults feel like lifes more than they can handle, they simply have to watch a comercial to undergo the (admittedly short lived) paradigm shift that maybe they are seeing the world wrong, and that the problem is in their preception. And that prozac will fix it, and make their problems go away.
There are a few outcomes to this.
a) They will natuarally adapt to their situation
(ie get better on their own) attribute it to
the ADb) They will never adapt to their situation
and blame it on the ADc) They will be stuck as a perpetual memeber
of the "placebo of the month" club
Its like "The emperors new cloths". All the adults sat there and pretended something was there, but it took a kid to point out the obvious.
There are square pegs in this community. And when we try and ram them into round holes stuff is going to come up.
Its all about creating socially aceptable personalities. Thats why serotogenics are so popular because serotonin civilizes people.
If there are chemically imballenced people, they are few and far between.
Just like I don't believe that half the class should be on ritalin. If half the class is "chemically imballanced" that says something about the system.
Linkadge
Posted by ed_uk on July 13, 2005, at 13:32:57
In reply to Re: Life is a chemical imbalance, what is normal » Declan, posted by linkadge on July 13, 2005, at 6:59:33
>Just like I don't believe that half the class should be on ritalin. If half the class is "chemically imballanced" that says something about the system.
Is half the class on Ritalin? LOL, what school do you go to?!
~Ed
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